Healthcare Provider Details

I. General information

NPI: 1578067971
Provider Name (Legal Business Name): REYN FUKUICHI HIGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1079 MOANALUA RD STE 450
AIEA HI
96701-4723
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 450
AIEA HI
96701-4723
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-7747
  • Fax: 808-229-1522
Mailing address:
  • Phone: 808-488-7747
  • Fax: 808-229-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-24719
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: